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THE JOURnALOF THE

AmERICAn ACADEmy Of BOLD fOIL OPERATORS

Officers and Committees, 1965-1966 . . . 50

Vol. IX September 1966 No.2

Annual Meeting Program . . . . . . . 53

........... 72

ROBERT B. WOLCOTT, EditorSchool of DentistryCenter for the Health ServicesUniversity of CaliforniaLos Angeles 24, California

RALPH A. BOELSCHE,

Business Manager1024 Esperson BuildingHouston 2, Texas

BRUCE B. SMITH

1110 Cobb BuildingSeattle, vVashington

GORDON J. CHRISTENSEN

Stimson BuildingSeattle, Washington

MILES R. l\1ARKLEY

632 Republic BuildingDenver, Colorado

President's Message

Donald K. Phillips

Barnum Honored

Histological Evaluation of

Gold Foil Restorations

Henry J. Bianco, D.D.S., M.S.

D. Vincent Provenza, Ph.D.

Dam Gems

. . . . 51

52

56

The Journal of tbe A111erican Acade111Y of Gold Foil Operators is publishedbiannually by tbe A11'lerican Acade1l1Y of Gold Foil Operators. Tbe opinionsexpressed in this publication by individual authors do not necessarily expresstbe views of tbe Acade711y, unless tbey are based upon reports adopted by tbeorganization. Tbe Academy reser·ves the rigbt to reject, condense, re·vise and editany article submitted for publication if it does not confor111 to tbe standards andobjecti7.,;'es established by tbe Editorial Board. 111 order to be considered for publication all articles 111ust be Sub111itted typewritten and double spaced, at leasttbree l1zontbs prior to tbe date of publication. Papers presented before any of" theA cadel1zy l1zeetings will beco111e the property of tbe A cademy and will be publislJed in tbe Journal as thue and space will per111it.

Printed in U.S.A. by the Pre111ier Printing C01npany, Fullerton, California

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OFFICERS AND COl\IMITTEES 1965 - 196bAlex W. Jeffery, President (Deceased)

Donald K. Phillips, President-ElectI-I. William Gilmore, Secretary-Treasurer

EXECUTIVE COUNCil

Donald K. Phillips, CbairnlanJose' E. i\1edina, V ice-Cbair111an

Donald K. PhillipsRalph J. Werner ('67)

Membership Committee

Glenn A. Sutton, Chair1nanCharles F. Bouschor (1968)\Villiam J. Brennan (1967)Melvin F. Rugg (1969)Jack G. Seymour (1970)

Rubber Dam Committee

Loren V. Hickey, Chair111anPaul A. MooreGeorge W. FergusonMichael J. MurrayMerryl D. Schulke

Program Committee

Donald K. Phillips, Chairman\Vallace 'V. JohnsonCharles F. Bouschor.lanles H. \Vick

Study Club Committee

Frederick A. Hohlt, ChairmanJan DiepenheimCarl T. l\'lonacelliD. Ed\vard NeilRalph A. Boelsche

School Committee

Gerald D. Stibbs, ChairnlanFletcher M. CraigKenneth R. CantwellPaul ~r. DawsonHoward 1. GilbertH. William GilmoreRonald E. Jordanl{obert R. TaylorJames P. VernettiKenneth V. Randolph

Constitution and Bylaws Committee

James P. Vernetti, ChairnlanRobert B. WolcottEugene Ziegler

50

Gerald Stibbs ('66)George A. Brass ('68)

Nominating Committee

William M. Walla, Sr., Chairn1anFloyd E. Hamstrom (1967)Ralph A. Boelsche (1968)

Necrology Committee

George .A.. EllspermanMerle B. McGeeCarl L. Boyles

State Board Committee

D. Jackson Freese, CbairmanHarry E. WeberHunter A. Brinker.lohan E. WoldLionel U. Bergeron

Visual Education Committee

Clifford H. Miller, Chair1nanPaul H. LoflinRobert .E. HampsonArthur J. MontagneH. William Gilmore

Research Committee

Lloyd Baum, ChairmanGeorge M. HollenbackHarold R. LaswellHarry RosenBruce B. Smith

literature and Publicity Committee

Gordon J. Christensen, Chair1nanHerbert J . UnderhillCharles ~1. StebnerRay E. Stevens, Jr.

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'7''te~'4 7Ite444geIn reviewing the messages from

the Presidents past, I am impressed\vith one outstanding characteristicof each of them, their devotion anddedication to the American Academy of Gold Foil Operators. Thisspirit prevails today anlong themembers I am sure. Evidence ofthis is in the excellent cooperationand help I have had from the officers, council members, committeeBlen and general membership during the time I have been actingpresident.

With all this help I am sure our...~nnual Meeting is going to beworth attending both from essaysand clinics.

Reading the messages bringsmemories of past meetings and

DONALD K. PHILLIPS places, memories of friends, somePresident of them no longer with us except

in spirit. All of this is good, but\ve cannot live in the past. Thanks to the efforts of these men theABlerican Academy of Gold Foil Operators is a living, very vital organization with objectives and purposes for the future.

Our programs, and the activities of the Academy and cOBlmitteesBlust be geared to the future, while retaining the best of the past. Byadding to our basic knowledge and experience the future of dentistrycan indeed be bright.

Members of this AcadeB1Y who are engaged in research are actively looking for materials or combinations of materials by whichwe can. better serve our patients. Research into preventive dentistry\\Till perhaps in time reduce the incidence and activity of carious processes. When such a time COlnes the stature of permanent fillings willbe Blore important than ever.

Hence, it is imperative that we perfect ourselves in the use ofthe most permanent of materials and the one that can be used in. theB10St conservative of cavity preparations.

The program for the annual meeting has been. tailored along thisline of thinking. All of us connected with the preparation. of theagenda hope you enjoy it.

DONALD K. PHILLIPS

;1

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13arnum 3{unored

On February 26, 1966, Dr. Donald K. Phillips, President-Elect,presented a plaque to the American Dental Association in honor ofDr. S. C. Barnum. This presentation ,vas acconlpanied with the following message by Dr. Phillips:

i\1r. President - etc.

Out in our part of the countrywe honor a man as the founder of.L~rbor Day with the phrase - "Hegave the \vorld a great idea - Planttrees." We would like to honora man here who gave to the dentalprofession a great idea - "TheRubber Dam."

Listed in the By-Laws of theAcademy of Gold Foil Operatorsunder objectives is the paragraph:

"I t \\Till encourage by practiceand by teaching the perfornling ofrestorative procedures in the bestpossible field in respect to operative cleanliness. In this phase ofits program it will utilize as itsmedium and its criterion of othermaterials - the rubber danl.

I t may be that the future will bring a better material than goldfoil, and a better operating field than that provided by the rubberdam. If and \vhen such is the case, the Academy will use and advocate the improvements after critical comparison and evaluation haveproved them to be such."

With this background for our sentiments it is only fitting thatthe Academy presents the Plaque in the memory of Doctor StanfordChristie Barnum, the man who gave to dentistry, not for his own profit,but for the good of the profession, the idea and technique of therubber danl.

It is our hope that it will occupy a place of honor and serve asan inspiration to men in the future to be as dedicated and unselfishwith regards to their chosen profession.

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Olnnual -MeetinqDedicated to the Memory of Dr. Alex W. Jeffery

PROGRAMThursday, November 10, 1966

Executive Council Meeting, Adolphus Hotel, Dallas, Texas

Friday, Novemb,e'r 11, 1966

Registration - Adolphus Hotel

Opening Dr. D. K. PhillipsInvocation Dr. Ralph Boelsche

Remarks,local arrangements chairman Dr. Charles BouschorIntroduction of Essayists Dr. D. K. Phillips

"Current Concepts Regarding Etiology and Preventionof Dental Caries"

Dr. David Bixler, University of Indiana, Indiana

"Direct Gold Restoration in the Adolescent Dentition"Dr. Carlo Delaurentis, Coronado, California

Coffee Break

a.rn.

a.m.

1:00 p.m.

/lWhy's and Why Not's of Cavity Preparations as SeenBy An Examiner's Eye"

Dr. Roy Fetterman, South Pasadena, California

Clinics - Baylor University School of DentistryCommercial DisplaysTable Clinics

6:00-7:00 p.m. Social Hour - Adolphus Hotel

7:00 p.m. Dinner and Annual Business Meeting

8:00 a.m.

8:30 a.m.

9:00 a.m.

10:30

10:45

10:00 a.m.

8:00 a.m.

9:00 a.rn.

9:30 a.m.

10:30 a.m.

Saturday A.M., November 12, 1966Baylor University

Continuation - ':Current Concepts Regarding Etiologyand Prevention of Dental Caries"

Dr. David Bixler, University of Indiana, Indiana

"Application of Rubber Dam in Pedodontics"Dr. Gene Sargent, Burlingame, Washington

"Gold Foil in Mandibular Anteriors/lDr. Paul Dawson, loyola University, Chicago, Illinois

Clinics ... Table Clinics ... Commercial Exhibits

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Friday P.M. Operators

Class V

John Coughlin

W. H. Wilson

L. E. Long

T. S. Gerald

D. J. Fong

H. L. Cox

James F. Alexander

Don H. loring

H. A. Cavness

Perry Powell

Bob Simon

loren Hickey

Paul loflin

Ron Heath

Willard Powell

Class III

Carlo Delaurentis

Harvey Imber

Tom Barker

Vic Lofgren

Stephen F. Dale

J. W. Carpenter

W. T. logan

Robert Mendenhall

W. B. Owen

Class III, Inc.

Bill K. Forbus

Joe P. McCloud

Class II

Kenneth longeway

54

lexington, Kentucky

Tulsa, Oklahoma

Tulsa, Oklahoma

Amarillo, Texas

Amarillo, Texas

Pampa, Texas

Pampa, Texas

Dumas, Texas

Hereford, Texas

Verrnillion, South Dakota

Clayton, Missouri

San Diego, California

Beckley, West Virginia

lansing, Michigan

Vermillion, South Dakota

Coronado, California

Belville, Illinois

Highland, Illinois

Lincoln, Nebraska

Tulsa, Oklahoma

lubbock, Texas

Borger, Texas

Colorado Springs, Colorado

Hereford, Texas

Dumas, Texas

Tulsa, Oklahoma

San Diego, California

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Saturday A.M.

Class V

Gene Sargent

H. W. Gilmore

N. E. Lyons

Ray Shaddy

Walter Williamson

Class III

Wiiliam M. Walla, Jr.

R. C. Wieland

Roy Fetterman

K. C. Christensen

Fletcher Craig

William J. Roberts

Carl L. Boyles

Patrick F. O'Brien

Burlington, Washington

Indianapolis, Indiana

Mountain View, California

Omaha, Nebraska

St. Louis, Missouri

Fremont, Nebraska

Lincoln, Nebraska

Pasadena, California

Lincoln, Nebraska

San Francisco, California

Houston, Texas

Houston, Texas

Portland, Oregon

NOMINEES FOR A.CADEMY OFFICERS

The Nonlinating Con1nlittee has subnlitted the names of the fol-lowing nlembers for offices during the 1966-67 ternl:

Dr. Donald K. Phillips President

Dr. Gerald D. Stibbs President Elect

Dr. Paul H. Dawson Vice-President

Dr. Hunter Brinker Member of the Council

Dr. H. Willian1 Gilmore Secretary-Treasurer

The balloting will take pl1ce at the annual business meeting onNovember 10, 1966 at the Adolphus Hotel, Dallas, Texas.

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3tistoloqical & valuation of

(folJ ffoil :J2estorationsHENRY J. BIANCO, JR., D.D.S., l\,I.S. A~D D. \TINCENT PROVENZA, PH.D.,

BALTI1\;1ORE, l\1ARYLAND

The effect of gold foil restorations on pulp has been a subject ofconcern among both basic and clinical investigators, yet a systematicsearch of the literature reveals that little has been accomplished toeffect continuity of the voids in knowledge that exist in this area.

The studies directly related to gold foil restorations (James andSchour, 1955; and James, Schour and Spence, 1959) indicate that theprocedures produced inflammation vvhich ranged in intensity frommoderate to high, that the intensity of inflammation was positivelyrelated to the depth of the cavity preparation and stinlulus and thatsecondary dentinogenesis was directly correlated to inflammatoryacuity.

The present study was conceived to observe the histological alterations in the dental pulp which are associated with gold foil procedures. Particular emphasis was directed to\vard the response of thepulp and dentin to cavity preparation and postoperative stimuli involved in gold foil restorations.

MATERIALS AND METHODS

Eight male Rhesus monkeys of an average of 4 years andaverage weight of 8.5 lbs. were used in this study. The operativeprocedures were performed under intravenous sodium nembutal afterthe animals had been premedicated by intramuscular demerol andatropine. While under anesthesia, the experimental animal was tattooedon the ear lobe for identification.

OPERATIVE PROCEDURES

Roentgenograms were taken prior to cavity preparation and/orimmediately after placing the restorations, depending on the accessibility of the x-ray unit. In this study, a Class V Ferrier cavity preparation (Fig. 1) was selected as the standard operative procedure.

Gold foil restorations were placed in the lateral and central incisors of the mandibular and nlaxillary teeth. One or two of the aforementioned teeth were used as controls and restored with zinc oxide

This study was supported by a grant from the United States Public HealthService, Grant No. DT 46 (C2).From the Departments of Operative Dentistry and Histology and Embryology,Baltimore College of Dental Surgery, Dental School, University of l\1aryland.

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57HISTOLOGICAL EVALUATION OF FOIL RESTORATIONSVOL. IX

NO. 2

and eugenol. A cuspid or bicuspid was used for normal histologicalstudy.

In conjunction with the rubber dam, a compound supportedS.S.W. No. 212 cervical clamp was placed on the tooth in order thatthe finished margin of the restoration might be established in thegingival cervice upon removal of the dam and clamp. This outlinewas followed in accordance with the principle of extension for theprevention of further caries progress. The outline form was geometrically a trapezoid with the base facing the incisal. Many variations ofthis basic form are used when caries are present. The instrumentsused in cavity preparation are indicated in Figure 1. Cavosurfacebevels were not utilized.

CLASS:SZ: FERRIER PREP

ff!\.'~l, ~lLJ\J 12-15- 312-15- 94

6-3-6

6-3-94

6(80) 2\- 9 R.4 LAllQIe Formers 8 (80)4 _8 Rl L

Figure 1. Cavity design and Instrumentation.

INSERTION AND CONDENSATION OF GO L D F 0 I L *

Pellets were prepared by cutting the sheets into 1/64 and 1/128of a sheet, rolling the pieces between the thumb, index and middlefingers. An Electro-Mallet was employed for condensation of thegold foil (Figure 2). A measuring device was constructed in orderthat the force applied during condensation might be determined. Thismechanism consisted of a sphygmon1anometer bulb, air gauge, a ~

inch aluminum piston in a brass housing and a handpiece bracket. Thepiston was brought into contact with the condenser point. When operation of the instrument was initiated, the pressure could be read directly from the gauge in pounds per square inch.

Annealed, 1/128 pellets were placed with a University of Washington B-12 foil carrier and maintained with a Woodbury 23 foilassistant. A triangular bar was placed froID the mesioaxioincisal pointangle to the mesioaxiogingival point angle. The bar was condensedwith a round 0.5 mm. straight condenser point.

*-Gold foil supplied by Morgan, Hastings and Company of Philadelphia, Pa.

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BIANCO AND PROVENZA J .A.A.G.F .0.

SEPT. 1966

The Electro-i\1.allet settings, the point sizes and the pellet sizesused in the various steps are contained in Table 1.

;8

Figure 2. Restorations compacted wi1 hElectromallet. Force of condensation ismeasured simultaneously.

TABLE ISummary of Condensation T.echnic

I

I

EIectro-Ma IIet I

Procedure Point Size Pellet SizeFrequency (mm) (fraction of

Intensity C.P.M. 4"x4 JJ Sheet)

Triangular IBar 2-3 400-600 0.5 round

I

1/128

GeneralBuild-up 4-6 1800-3600 0.5 round 1/128

0.5x1.0 1/64

After Con-densation 6 3600 1x18-3-3

Base speed "vas constant at minimum.

Upon anchoring the triangular bar the foil was condensed overthe axial wall and banked against the surrounding walls, thus forming

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VOL. IX

No.2HISTOLOGICAL EVALUATION OF FOIL RESTORATIONS 59

a saucer-shaped mass. Pellets extending over the enamel margins wereburnished to protect the enamel rods and to insure good adaptation.This procedure was executed with the 0.5 mm. round and theO.5xl.0 parallelogram points. The general build-up of the concavitywas accomplished with the parallelogranl. A foot condenser (lxI8-3-3)was then employed to finish the contour and to post-condense thesurface.

Appreciable overfilling was avoided so that finishing factorswhich might have added to the pressure employed during condensation were obviated. All of the experimental teeth used were preparedand condensed in the Inanner described.

DURATION AND PERFUSION TECHNIC

The experimental interims for the animals were as follows: two24 hours, one-3 days, one-7 days, one-4 ",reeks and two-9 to 10 months.

Death was induced by rapidly injecting 5-10 cc. of undilutedsodiunl nembutal, or by fixative perfusion.

FIXATION

A variety of fixation procedures 'was employed, the most successful of which involved smaller tissue segments which were treatedunder vacuum. The vacuum pump used for the oven was connectedto a series of 3 flasks (Fig. 3). The first flask remained enlpty, thesecond contained water and the third contained the specimen withcold 10 per cent neutral formalin. Water was placed in the secondflask to absorb vapors emanating from the third flask containingforrnalin.

~~~

EMPTY WATER FOAMALI~

Figure 3. Procedure for fix·ation of specimens.

HISTOLOGICAL TECHNICS

Upon cOlnpletion of the fixation period, the specimens were prepared for demineralization. They were processed first by washingin tap water for approximately 24 hours, followed by 72 hour changesof 5 per cent fornlic acid buffered with sodium citrate to pH of 3.2.Complete decalcification required an average of 32 days. This process

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BIA~CO AND PROVENZA J .A.A.G.F.0.

SEPT. 1966

was not considered conlplete until a radiograph showed a uniformradio-opacity.

The specimens were re\vashed with tap water, tagged, placed inan autotechnicon and processed overnight. The tissues were thenplaced in a vacuum oven at 58°C and infiltrated with paraffin at 28

60

TABLE IIClinical Histolo,gical Data

i "Spec jmen8

Clin ical Histological

Pulp Type andDitchingTooth Prep. Condo Remaining Cavity Response Anu>unt of

Number Time Time Dentin Depth CMild

Reparative byDura- Dentin #212tioll

No. F-Foil in in in in ++) Moderate ClampZ-ZnOE Min. Min. rom mm +++ Severe fI~ Irreg. (+)

J Rec'~ Recovery R Reg.

24 1 7-F 10 10 1.0 0.50 +++ +2 8-F 10 13 1.3 0,45 +++ +

J[3 g-F 12 12 1.3 0,40 ++

0U 4 10-Z 10 - 1.1 0.50 ++

n!) 24-Z 8 - 1.2 0,40 ++

S6 25-1" 8 10 0.9 0.75 +++7 26-F A 10 1.1 0.50 ++

3 8 7-1" 10 15 0.6 0.70 +++9 8-I-' 10 17 1.0 0.60 ++

D 10 9-Z 10 - 1.1 0.50 ++A 11 24-Z 7 - 1.1 0.50 +++Y 12 25-1" 8 12 O.A O.AO +++S 13 26-F 8 10 0.4 O. g5 +++

7 14 7-1" 7 12 0.6 0,40 +++15 8-F 15 18 1.1 0,40 ++

D 16 9-Z 10 - 0.9 0.50 +A 17 24-F 8 10 1.1 0,40 +++y 18 2;)-F 10 12 1.0 0.45 +++S 19 26-F 8 12 O.g 0.50 ++

1 20 7-F 12 15 0,4 1.00 **++++ 1-0.0321 8-F 10 15 1.3 O.AO ++ 1-0.06

W 22 9-F 12 20 1.3 0.7!) ++ 1-0.04 +E 23 10-Z 10 - 0.8 0.80 ++ 1-0.02E 24 24-F 8 12 0.6 0.60 +++ I-O.O:!K 25 25-F 8 10 O.g 0,40 ++ 1-0.034 26 7-F 9 14 0.8 O.GO +++ 1-0.10W 27 8-F 10 15 1.0 0.60 +++ 1-0.10E 28 g-1" 15 15 1.1 0.60 ++ 1-0.10F. 29 23-Z 6 - 0.5 0.85 +++ 1-0.05K 30 24-F 7 10 0.8 0.60 +++ 1-0.10S 31 25-F 7 9 0.7 0.70 +++ 1-0.10 +

32 7-1" 10 20 0.9 0.50 Hec t H-0.40

933 8-F 12 25 1.2 0,40 Rec ++) n-0.2334 9-F 10 25 1.0 O.GO Hec +) R-0.32

T 35 10-Z 8 - 1.0 0.50 Rec H-0.050 3G 23-F 10 12 0.85 0.50

nec r+l R-0.30

1037 24-F 8 g 1.0 0,40 Rec ++ R-0.2838 25-F 10 10 0.9 O.GO nec +) R-0.30

H 39 26-Z 8 - 0.9 0,40 llec ++) *It-*n-0.400 40 7-F 8 15 1.2 0,40 Ree (++) R-0.20N 41 8-F 11 18 1.2 0.50 Hee R-0.35T 42 9-F 12 20 1.4 0.30 llee R-O.25II 43 10-Z 8 - 1.0 0.35 !lee R-0.05S 44 23-Z 9 - 0.9 0.40 Ilee R-0.I0

45 24-F 7 12 1.0 0,40nec r~ R-0.20

46 25-F 7 10 0.9 0.45 Rec + R-O.ll47 26-F 8 g 1.1 0,40 Ree + R........0.20

Avera~es 9 14 0.96 0.54

*35 Fo ilsand 12 ZnOE - Average Reparative Dentin in Mm.

**Poss i ble Absce8s Duration Foil ZnOE

***ZnOJ·; partially present at sacrifice. 1 Week 0.036 0.024 Weeks 0.10 0.059 to 10 Months 0.26 0.066.

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VOL. IX

~O. 2HISTOLOGICAL EVALCATION OF FOIL RESTORATIONS 61

pounds pressure for an average of 90 minutes. The specimens werethen embedded first in "Tissuemat" and later in "Paraplast."

Serial sections, 6 to 8 microns, were stained with hematoxylinand eosin.

RESULTS

Explanation of Data Chart

The pertinent clinical and histological data is summarized InTable II.

Serial sections of 60 specin1ens "\vere examined. Forty-seven wereacceptable for recording, 3 were cariously exposed, 10 were discardedbecause of inadequate fixation.

The number appearing in the third column of the chart indicatesthe location and type of tooth examined. The letter adjacent to thenumber indicates the n1aterial placed into the cavity preparation. Forexample, (7F) refers to the m:lxillary right lateral incisor with a goldfoil restoration, (2 3Z) refers to the n1andibular left lateral incisor witha zinc oxide eugenol control.

The average an10unt of dentin remaining after cavity preparationwas 0.96 mm. l\!leasurements were n1ade from the center of the cavityand in a line approximately perpendicular to a line tangent to thesubjacent pulp. The an10unt of dentin removed by instrumentation\vas measured and the average was 0.54 mm. The average total amountof cervical dentin was, therefore, 1.50 111m.

\ The criteria used in con1paring the extent of pulpal response aredefined as follows:

The pulp tissue was divided into t\VO portions - the superficialIJyer and the pulp core. Included in the superficial layer were theodontoblastic layer, the zone of Weil and the cell-rich zone. Theremaining portion \vhich contains the bulk of the supporting tissuewas referred to as the central area or core. Figure 4 illustrates normalpulp tissue with the indicated areas.

A code was employed to express the approximate location andextent of tissue response based on the layer or area of tissue that wasaffected. Thus, a lesion limited to the odontoblastic layer was gradedas mild (1\1), one extending into the subodontoblastic layers as moderate (1\100) and one involving the core of the pulp tissue as severe(S). The amount of reparative dentin, irregular (I) or regular (R),\vhich appeared during recovery was measured in millimeters.

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62 BIANCO AND PROVENZA J .A.A.G.F.O.

SEPT. 1966

Figure 4 Figure 5

Figure 4. Normal pulp tissue: 00, Odontoblasts; ZW, Zone of Weil; CIR, cell rich zone;BV, capillaries; PC, pulp cores; PO, predentin.Figure 5. Ditched cementum resulting from operative procedure at arrow.

Figure 6A Figure 6B

Figure 6A & 6B. Twenty-four hour post-operative response: (A) Foil, (B) Control.Figure 6A. Hyperemic pulp. Compare inflammatory response with normal pulp in

Figure 4.Figure 6B. Disruption of odontoblastic area at site of cut dentinal tubules at arrow.

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VOL. IX

:\10. 2HISTOLOGICAL EVALL'ATION OF FOIL RESTORATIONS 63

Results involving the animals in the long term experinlents (9 to10 months) required additional coding because of the changed histological features of the pulp tissue and dentin. Recovery-data weredetermined by comparison with normal, controlled and the previouslyexanlined experimental pulp tissues. The reparative dentin was measured, and if odontoblastic activity was still present, one or more plussigns (+) appear after the recovery symbol (Rec.), i.e., according tothe relative amount of odontoblastic activity.

When a groove or ditch appeared in the cementum (Fig. 5) asa result of the operative procedure, a positive sign (+) was placedin the designated colunln.

HISTOLOGICAL FINDINGS

Tr-u:cnty-four Hour [Juration. The 7 specinlens in this groupnlanifested definite evidence of tTIoderate to severe pulpal responses(Fig. 6 A and B). The disruption of the odontoblastic layer was confined to the area of the cut dentinll tubules. The zone of Weil, whichis normally cell-poor, demonstrated evidence of initiatory fibroblasticand leukocytic infiltration. The blood vessels were dilated with somemargination of leukocytes, with accomplnying moderate edema inboth the superficial and central portIons of the pulp tissue. The 4teeth restored with gold foil \vere sin1ilar in appearance to the 2 control teeth, except that in the latter edenla \vas for the most part re-

Figure 7 Figure 8

Figure 7. Three day post oper3tive response to foil showing leukocytic infiltration.Figure 8. Seven day response to gold foil indicating mild pulpal inflammation.

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66 BIANCO AND PROVENZA .J .A.A.G.F .0.

SEPT. ] 966

Figure 13 Figure 14

rigure 13. Ten-month foil response. Reparative dentin can be seen. Pulp tissue appearsnormal following rep-air.Figure 14. Reparative dentin under caries and cavity preparation. Similarity is noted.CP, cavity prep-aration; rCP, reparative dentin under cavity preparation; re, rep~rative

dentin under caries.

The fourth control had 0.40 nlm. of reparative dentin, but the dressingwas absent at the tinle of death.

Speci711ens W itb Caries. Two of the teeth utilized contained lingual cervical caries. Since these lesions were not extensive, cavitypreparations \vere made and foil was condensed into 2 of the specinlensand the third was restored with zinc oxide and eugenol. One of thefoil specimens \vas definitely in a state of severe distress, while theother exhibited signs of recovery (Fig. 14). The reparative dentindue to caries is very similar to that produced experimentally. Thezinc oxide and eugenol control indicated less repair than the foil specimens.

DISCUSSION

That any change in the nornlal climate of the dental pulp, likeany other tissue in the body, will elicit a response has been established. 3 , 19 The stimulus involves all of the instrumentation and procedures required to complete a geld foil restoration. Accordingly, aspecific group of dentinal tubules \vhich were normally protected bya layer of enanlel have now been exposed to the atmosphere. Dueto the cavity preparation and the subsequent forces of condensation,the dentinal tubules and the protoplasnlic processes of the odontoblasts

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VOL. IX

No.2HISTOLOGICAL EVALUATION OF FOIL RESTORATIONS 67

have not only been exposed to the atmosphere, but have been cutand subjected to other insults. Since the pulp tissue is to a greaterextent responsible for tooth vitality and since it is histologically similar to other loose fibrous connective tissues, responses initiated by thecellular, intercellular and vascular components of the dental pulp areto be expected. If the reactions are consistent with the pathognomonicchanges of connective tissue, an inflammatory process will follow. O'nthe other hand, caution must be exercised in absolute evaluation sincethe histologic picture presented by the prepared specinlens cannot beexpected to reflect in vivo conditions.

The initial sign observed in the dental pulp was that of acute inflammation. Concomitant activity relative to vascular changes andexudation of fluid was demonstrated in the 24-hour, 3-day and 7-dayspecinlens. By the second week the inflammatory process was accompanied by reparative dentin formation which would be sinlilarto the healing phase or scar formation of connective tissue. 3 ,19 It wasinteresting to note the rapidity and irregularity of the reparative dentinogenesis fronl the onset of repair to the fourth week. During thisinterval the quantity of repair tripled (0.03 mm. to 0.10 nlnl.). In 10months the amount of reparative dentin ,vas again nlore than doubled(0.26 mm.) and the outline was nlore regular in appearance. The cellu-lar activity in the 10-month specimens was confined to the superficiallayer adjacent to the reparative dentin. This zone contained sonleodontoblastic ac6vity with small localized areas of lymphocytes denoting (a) a chronic state of inflammation and (b) that complete recovery is definitely an extended process. The central portion of thepulp was much less edematous, the vessels were diminished in caliberand the cellular and intercellular components were relatively normal.Complete recovery was not present in any of the specimens.

Because of the high thermal conductivity of gold foil, the depthof the prepared cavity and the condensing forces during foil insertion, more aggravated irritation of the pulp was anticipated. It ispossible that all of these factors may contribute to the sustained presence of lymphocytes and odontoblastic activity. The magnitude ofthis effect is as yet undetermined and bears further investigation.

A dramatic illustration of cause and effect is observed when conlparing the dental pulps over a IO-month period. Even more important than establishing the presence of inflalnmation as a responseevoked by an operative stimulus is the ability of the pulp tissue torecover from the stimulus. This is the real point of issue when examining the effects of a dental material and technic being used in vivoby the dental practitioner.

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BIANCO A~D PROVENZA J .A.A.G.F.0.

SEPT. 1966

Ogilvie 13 in his report, indicated that the cervical clamp may beresponsible for the ditching of the cerrlentum and resorption of thelabial crest of alveolar bone. While these observations were confirnled in this project, further involvement of the dentin was noted.Whether this phenomenon is solely a product of the cervical clampor combined effect of clamps as well as disc and files is unresolved.It is quite possible that the latter t,vo playa more destructive part inditching.

70

In retrospect one nlight conclude that the data extracted fronlthe literature and those of this project reveal several common conditions. It is significant that the intrinsic defense mechanism of the pulptissue to combat external irritants of the magnitude employed duringgold foil technics was well illustrated in this study. The potency ofthis mechanism was demonstrated by the amount of reparative dentinpresent in 10 nl0nths as a result of gold foil manipulation. Investigations employing other materials such dS silicates, high speeds, resinsand amalgams have demonstrated that sinlilar pulpal responses occur.5.6.21.22.23 The relative effect of gold foil, however, seemed toevoke a more acute and rapid response. 13

The results do, however, indicate the inlportance of selecting onlythose teeth in which the biological conditions are favorable to the procedure. This applies to all phases of restorative dentistry, but is a1110re critical factor in gold foil technics. Further study is indicatedto determine the optimum force which can be tolerated by the dentaltissue.

SUMMARY AND CONCLUSION

This study indicates that gold foil technics v/ere traumatic to thepulp tissues. Although tissue recovery was slow, there were indications that damage "vas sustained by the dental tissue. Repair was confined to the dentinal tubules directly associated with the stimulus, andthe repair was located apical to the cavity preparation due to the histological configuration of the dentin. Thus, according to the data presented, the various lines of force induced during the condensation ofgold did not transmit impulses to other areas of the pulpal tissuethereby evoking a more generalized r~sponse. Conclusions based uponthe nl0re general response are no longer valid since the tissue reactionsare qualitatively similar to those produced by other restorative materials, but which quantitatively are somewhat greater.

The authors express their gratitude to Sue-ning C. Barry,PH.D., Herbert Wolford, D.V.lVi., Ramesh C. Sardana, B.D.S.

and Charlotte R. Bianco for their assistance and interest inthe execution of this project.

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VOL. IX

No.2HISTOLOGICAL EVALUATION OF FOIL RESTORATIONS

REFERENCES

71

1. Bender, I. B., Seltzer, S. and Kaufman, I. ].: Infectibility of Dental Pulp byWay of Dentinal Tubules, J.A.D.A., 59:466, 1959.

2. Bernier, ]. M., and Knapp, M. ].: A Ne\-v Pulpal Response to High-SpeedDental Instruments, Oral Surgery, Oral Medicine and Oral Pathology, 11: 167,1958.

3. Bhaskar, S. N.: Synopsis of Oral Pathology, pp. 143-153, St. Louis, Mosby,1961.

4. Brannstrom, 1\11.: Cavity Preparation and the Pulp, Dental Progress, 2:4-8, 1961.5. Dubner, R. and Stanley, H.: Reaction of the Human Dental Pulp to Teln

porary Filling J'v1aterials, Oral Surgery, Oral Afedicine and Oral Pathology,15: 1009-1017, 1962.

6. Gurley, W. and Van Huysen, G.: Histologic Response of the Teeth ofDogs to Operative Procedures, J. Dent. Res., 19: 179, 1940.

7. James, V. and Schour, 1.: The Effects of Cavity Preparations and Z:ncOxide and Eugenol Upon the Human Pulp, J. Dent. Res., 34:698, 1955.

8. : Early Dentinal and Pulpal Changes FollowingCavity Preparations and Filling 1\llaterials in Dogs, Or'al Surgery, Oral M edicine and 011'al Pathology, 8:1305-1314, 1955.

9. James, V., Schour, I. and Spence, ].: Biology of the Pulp a:1d Its fJefense,].A.D.A., 59:903, 1959.

10. Kramer, I. and J'v1cLean, ].: The Response of the Human Pulp to Self-polymerizing Acrylic Restorations, Brit. Dent. J., 92:255, 281, 311, 1952.

11. Lefkowitz, W., Robinson, H. and Postle H.: Pulp Response to Cavity Preparation, J. Prostbetic Dentistry, 8: 315,1958.

12. Lefkowitz, W.: The Pulp and Operati\Te Dentistry, J. Dent. Medicine, 17: 3,1962.

13. Ogilvie, A. L.: Lital Factors Interrelating Periodontology and RestorativeDentistry, J. A'l7zer. Acad. (]old Foil Operators, 4: 15, 1961.

14. Orban, B.: Odontoblasts in Dental Tubuli, ]. Dent. Res., 20:553, 1941.15. Seltzer, S., Bender, I. B. and Kaufman, I. ].: I-listologic Changes in Dental

Pulps of Dogs and Monkeys Following Applications of Pressure, Drugs, andMicroorganisms on Prepared Cavities, Oral Surgery, Oral M ediciJ'ze and OralPathology, 14:327, 1961.

16. ~ : Histologic Changes in DentalPulps of Dogs and Monkeys Following Application of Pressure, Drugs andMicroorganisms on Prepared Cavities, Part II. Changes Observable iVloreThan One Month after Application of ~rraumatic Agents, Oral Surgery,Oral Medicine and Oral Pathology, 14:856, 1961.

17. Stanley, H. R.: The Factors of Age and Tooth Size in Human Pulpal Reactions, Oral Surgery, Oral 1i\1edicine and Oral Pathology, 14:498, ]961.

18. Stanley, H. and Swerdlow, H.: Biological Effects of Various Cutting1\,1ethods in Cavity Preparation: The Part Pressure Plays in Pulpal Response,J.A.D.A., 61 :450, 1960.

19. Stones, H. H.: Oral and Dental Diseases, pgs. 246, 354, Williams and \Vilkins,Baltimore, 1962.

20. Swerdlow, H. and Stanley H.: Reaction of Human Dental Pulp to AmalgamRestorations, J.A.D.A., 56:317, 1958.

21. : Reaction of the Human Dental Pulp toCavity Preparations, Part II. At 150,000 RPM with an Air Water Spray,J. of Prosthetic ]Jentistry, 9: 121, 1959.

22. - . : Response of the Human Dental Pulp toAmalgam Restorations, Oral Surgery, Oral Medicine and Oral Pathology,15:499, 1962.

23. Zander, H. A.: Pulp Response to Restorative Materials, ].A.D.A., 59:911, 1959.

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It is the intent of the Rubber Dam Corn'fJlittee to publicize,Cit regular intervals, various techniques that will be of useto students and practitioners. SO'fJle of these will be timeproven and others will be new. Your comments, suggestions and ideas for assisting others with various steps of damtechniques r'will be appreciated. If photographs are necessary, the Con1mittee will rnake every effort to be of assitance to you. Please send your ideas to Cdr. Loren V. Hickey, DC, USN, Dental Service, U.S. Naval Hospital, San]Jiego, California 92134.

SAFETY PRECAUTION

In placing clanlps on partially erupted or short teeth, aclamp may be disengaged andbecome lodged in the throat oraspirated into the trachea. Along piece of dental floss fastened to the bow, and hung fromthe mouth can provide an excellent safety measure as illustrated.

Suggested By: Dr. Donald K. Phillips" Nebraska City, Nebraska

ORIENTATION OF DAM

~r0 assist in orientation of theedges of the rubber danl priorto attaching the holder, it is veryhelpful to punch the upper leftcorner of the dam at the sametime the rubber dam is punched.

Suggested By:

Dr. James P. Vernetti,Coronado, California

72

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The

UNION

FOR A LONG LIFE!Only the Gold Foil can last for thelongest lifetime because only the GoldFoil forms with the natural tooth aunion that is interlocked and tight!And such a union is made best with~~M-H" Extra Pliable Cylinders.

A perfect balance of cohesiveness andsoftness makes them the easiest-working Foil ever offered to the dentaIprofession. Responding to the co n-

denser instantly, they pack easily andrapidly into a dense, resistant restoration of great edge-strength and unsurpassed hardness. They do not balk atthe condenser, but follow pliantly,going true to the mark the very firsttime they are condensed to place.

Feel their responsiveness under yourown condensing point. Enjoy thrillingdelight you never experienced before!

MORGAN, HASTINGS & CO.2314 Market Street, Philadelphia 1, Pa.

Please send, through IllY dealer, 1/40 ()"~.

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Doctor....._.... -- . . ._. .-.. _. " ..

Address__ _.._ _ _ _ _ __ . ._

Dealer__ _._ .. __ _ __ .. __ _.._ .

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ELECTRO - MALLET

(~Ol\'rPACT

Operates on the new principle of high-frequencymalleting at reduced intensity without sacrifice offoil density. Easier for operator. Less trauma for patient.This has been proved in leading Dental Schools and inpractice by nationally recognized foil operators.

The Electro - Mallet is equally advantageous forcondensing amalgam.

A 3D-day trial without obligation to purchase isavailable. Please write for details.

McShirley Products6535-41 San Fernando Road Glendal,e, Calif 91201

Phone - 213/243-8994

74

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Pure latex dental dam in cutsand thicknesses to meet therequirements of every restorativeoperation and for many otherprocedures which demandisolation or protection.

DAM IN ROLLSV2 sq. yd. roll-5" or 6" wide1 sq. yd. roll-5" or 6" wideLight or Dark ColorThin, Medium, Heavy, Extra Heavy or SpecialHeavy Gauge (Special Heavy-Dark only)

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STERILE DAMEach piece individually packagedto keep it sterile until used.5" squares-3D pieces per pkg.6" squares-3D pieces per pkg.Light or Dark - Mediurn only.

AKRON. OHIO 44310

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76

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Superb "Silver Service"

For the "bread and butter"of your daily practice

Dental authorities agree that silver arnalgam is the "bread and butter" of

the average dental practice. Thousands of dentists throughout the worldagree that New True Dentalloy provides superb "silver service." Here are afew of the reasons why:

High degree of purity requires less mercury for smooth amalgarnation.Graded particle size results in wax-like consistency for easy carving. Highcompressive strength makes normal occlusal stresses well-tolerated afterone hour. Carefully controlled expansion assures safe, tight marginal seal.

For superb "silver service" for you and your patients, always insist on the

amalgam alloy from S. S. WH ITE COMPANY, Philadelphia, Pa. 19105.

NEW TRUE DENTALLOY®This product appears on the American Dental Association list of certified dental materials.

BOTTLES TABLETS

Q~~S.S.WHITE®

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2 RECOGNIZED AND ACCEPTED AIDSTO SUCCESSFUL AND ENDURING

oTOOTH RESTORATION

WILLIAMS MAT GOLD is an interlaced, interlocked,crystalline product of the highest purity ever marketedcommercially. After proper annealing to expel air-bornecohesion impairing surface deposits, it may be condensed by standard methods into masses of a densityand hardness comparable to a Type A gold casting. Forease of working, and where indicated, there is nosuperior filling material.

WILLIAMS MAT-FOIL is Mat Gold with a thin overlay ofgold foil covering the surfaces. It has been developedfor ease of handling and results in a restoration ofoutstanding density.

Mat crystals magnified about 100 times. This shows the "pine tree" effectwhich makes it possible for the interlocking of particles. Also, this configurationgives a greater surface area to enhance cold welding.

Your special introductory outfit supplies MatG GO~da~~~~:~i~:~c~e~~~~d :elaUI~~e~O~o~:t~~ ai~~ro_

WILLIAMS GOLD REFINING COMPANY, INC.2978 MAIN STREET BUFFALO 14, NEW YORK

and WILLIAMS GOLD REFINING CO. OF CANADA, LTD.FORT ERIE ONTARIO

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79

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IVORY RUBBER DAM PUNCH

DESIGNED inSta in less Steel

Only a clean cut hole in rubber stands extensive stretching. Raggededges tear easily. This design pern1its the punch to move up anddown in a straight line, thus insuring a perfect cut hole in the dam.A moderately large hole will exclude moisture better than one toosn1al1. The six different size holes in the disk ll1eet your every requirement. A real feature is the fact the disk may be resharpened orreplaced.

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GOLD FOIL ANNEALER

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80

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